Background In rare cases, Behcet's disease (BD) can cause severe aortic regurgitation (AR) or aortic root destruction that might have lethal outcomes. Conventionally, simple aortic valve replacement (AVR) is performed for the management of severe AR in BD patients; however, the reoperation rate is as high as 78 to 100%, while mortality rate range from 20 to 47%. Recently, several series of case reports showed that compared to AVR, aortic root replacement (ARR) improved the surgical outcomes of AR in BD patients.
Objectives To identify the factors associated with the long-term surgical outcomes of AR in BD patients.
Methods We identified 23 patients who had been surgically treated for AR caused by aortic root involvement of BD from January 1996 through December 2013. We evaluated the occurrence of post-surgical adverse events, which were defined as follows: death, aortic valve/graft problem, infective endocarditis, cerebral infarction, and/or re-operation of aortic valve or root. Types of surgery were classified as simple aortic valve replacement (AVR), bioprosthesis aortic root replacement (bARR), and mechanical valved composite graft aortic root replacement (cARR). Clinical parameters including baseline characteristics, C-reactive protein (CRP), erythrocyte sedimentation rate, and medications were extracted from electronic medical records.
Results Appropriate aortic valve or root surgery cases were 35 in total, with a mean follow up duration of 11±5 years in 23 patients. Out of the 11 cases that underwent AVR, post-surgical events were observed in 8 (73%) cases. Out of the 12 bARR cases (xenograft in 5 cases and homograft in 7 cases), 9 (75%) cases had post-surgical adverse events. Out of the 12 cARR cases, post-surgical adverse events occurred in 4 (33%) cases. Multivariable cox proportional hazards model indicated that levels of CRP at 1 month after discharge and age at operation were independent prognostic factors associated with event-free probability. Notably, performing cARR was the most significant factor that affected the surgical outcome (HR (95% CI) 0.147 (0.028 – 0.766), p=0.023).
Conclusions In BD patients with severe AR, the occurrence rate of post-surgical adverse events was associated with the levels of CRP at 1 month after discharge, age at operation, and type of surgery. cARR may be a better surgical option in BD patients with aortic root involvement
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Disclosure of Interest None declared